ADHD Medication Chart

Methylphenidate Based

Medication	Form	Dose/Schedule	Dose Range	Onset/Duration	Most Common Side Effects	Pro	Precautions
Methylphenidate (MPH) Ritalin Methylin	tablets IR 5, 10, 20 mg chewable IR 2.5, 5, 10 mg liquid IR 5 mg/5ml 10 mg/5ml	Usually given two or three times a day. Begin 5 mg early AM & noon.	Child: 5-45 mg Adoles: 10-60mg Adults: 20-80mg	onset: 15-20 min duration:4 hrs max	Decreased appetite, decreased sleep, less common: headaches, stomach aches, irritability, weight loss, tics, “rebound”. Can overstimulate or make too calm if dose is too strong. These are true for all stimulants listed on the first two chartsSame as above.	EVERY MEDICINE ON THIS TABLE IS (MPH) METHYLPHENIDATE BASEDMethylphenidate is the generic name of all these. Works quickly, effective often. The most studied. Little to no lab testing needed. Good safety history. Methylin has no dye, is very small, and comes in grape chewable and liquid. Focalin is a refined isomer form which may be better tolerated and smoother.	Caution if history of tics or Tourette’s or high blood pressure or heart problems. Controlled substance. Must hand write all scripts, no refills, no call ins. True for all stimulants listed on the first two chartsSome kids get “meaner” with stimulants, especially amphetamines listed on second chart.
Focalin (dexmethylphenidate)Focalin XR	tablets IR 2.5, 5, 10mgFocalin XR comes in 5, 10, 15, 20, 25, 30, 35, 40mg			Focalin: 4-5 hrs. Foclin XR: 8 hrs.
methylphenidate-SR Ritalin-SR Methylin ER Metadate ER	tablets 10mg SR 20mg SR10mg ER 20mg ER	Begin 10 or 20mg SR in AM, may need increase or noon dose. May need regular Ritalin to start in AM or extend duration to PM. All 4 of these are time release capsules.	Child: 10-40 mg Adoles: 20-40 mg Adults: 20-80 mg	onset: 30-60 min duration: 5-8hrs		These are longer lasting versions of methylphenidate. Avoids noon dose, usually. Concerta is a methylphenidate in a clever osmotic pressure release mechanism pill. Metadate CD uses a third mechanism to extend the duration and smooth the effect of methylphenidate. Metadate CD, Ritalin LA, Aptensio XR, and Focalin XR capsules can be pulled apart and sprinkled on food. Quillivant is a time release liquid while Quillichew is a chewable time release pill. Daytrana is a skin patch.Metadate CD is 30% IR + 70% ER Ritalin LA is 50% IR + 50% ER
Concerta ER	18, 27, 36, 54mg	Once a day in AM.	Child: 18-27mg Adoles: 27-54mg Adult: 36-72mg	onset: 15-30 min duration: 8-10 hrs.
Metadate CDRitalin LA	10, 20, 30, 40, 50, 60mg CD capsule10, 20, 30, 40mg capsules	These 2 are time release capsules.Start 10-20mg AM Give once a day in AM Max is 60mg/d	Child: 10-40mg Adoles: 20-40mg Adult: 20-60mg	onset: 30 min. duration: 6-8 hrs.
Quillivant XR Quillichew ER	Liquid suspension 25mg/5ml (5mg/1ml) Chewable tablets 10, 20mg scored 40mg is not scored	Once a day in AM 10-20 mg start	10mg/d = 2 ml20mg/d = 4 ml30mg/d = 6 ml40mg/d = 8 ml50mg/d = 10 ml Child: 10-40mg Adoles: 10-60mg Adult: 10-60mg	onset: 30 min duration: 8-12 hrs.onset: 30-60 min duration: 8-12 hours	Same as above.	The only time release liquid stimulant.The only chewable extended release ADHD med. Releases biphasic 30% IR + 70% ER	Comes as powder in bottle, add water, shake vigorously before each use. Refrigerate. Use dropper to measure.Brand only – 2014New formulation 2016 Brand only
Aptensio XR	capsule 10, 15, 20, 30, 40, 50, 60mg	Once a day in AM Start 10 mg	Child: 10-40mg Adoles: 10-60mg Adult: 10-60mg	onset: 30-45 min duration: 8-12 hours	Same as above.	Another capsule option. Can be sprinkled on food. 40% immediate (IR) and 60% delayed release.
DAYTRANA (methylphenidate transdermal system)	patch 10, 15, 20, or 30 mg/9 hours	One patch per day to hip in early a.m. Remove after 6 to 12 hours – 9 hours is advised.	Child: 10-20mgpatchAdoles: 15-30mgpatchAdult: 15-30mg	onset: 2 hoursduration: 1-2 hours after patch removed	Same as above plus patch may irritate skin.	Although not designed to be cut, patch can be cut to lessen dosage. Avoids oral dosing. Should cover school day and longer. Duration can be adjusted by time patch is put and removed. May be smoother. Patch can be removed early to shorten duration.	Slow onset.Patch may come off accidentally. Patch may rarely lastingly discolor skin. Even low dose patch may be too strong for a child. Brand only.

Simultaneous use of alcohol or cigarettes and especially street drugs should be avoided. All medications should be avoided if possible in pregnancy. This chart is intended to be a summary guide, not a full and complete list.

Amphetamine Based

Medication	Form	Dose/Schedule	Dose Range	Onset/Duration	Most Common Side Effects	Pro	Precautions
DEXEDRINE (dextroamphetamine)	tablet (scored) IR 5mg 10mg	Same as Ritalin	Child: 2.5-30 mg Adoles:10-45 mg Adults:10-60 mg	onset: 30 min duration: 4-5 hrs	Same as Ritalin (MPH) – see 1st chart	Stronger and longer effect than Ritalin (MPH). Some people do better with amphetamines. Generic available. Avoids noon dose, usually. Generic available.IR Usually once or twice a day. Two doses usually cover a whole day. The XR form should cover the whole school day but may require an after-school IR boost. The XR capsule can be opened and sprinkled on food. Generics are available. Adderall is the most abused stimulant. 25% L and 75% D – amphetaminesStimulants, especially amphetamines, can help narcolepsy.	Precautions same as Ritalin (MPH) but more so regarding growth, heart, blood pressure, tics, speedy, agitation, anger and abuse.Inappropriately, I believe, all amphetamines are FDA approved down to age 3, while milder MPH is only approved down to age 6.Adderall is combination of two types of dextroamphetamine and two types of amphetamine.Adderall is the most abused. Adzenys and Evekeo have similar potential as they are also combinations of both amphetamine and dextroamphetamine.Approved use as diet or binge eating treaments is questionable to me.
DEXEDRINE – SR	spansules SR 5mg 10mg 15mg	Begin 5mg in early AM. May only need once a day. May need regular Dexedrine in AM to start effect early, or afternoon dose to extend effect in afternoon.	Child:5-15 mg Adoles: 10-30 mg Adult: 10-40 mg	onset: 30-60 min duration: 6-8 hrs	Same as MPH – see 1st chart Less rebound in longer lasting medicines.
ADDERALL dextroamphetamine and amphetamineADDERALL-XR	tablet (scored) 5, 7.5, 10, 12.5, 15, 20, 30mg IRcapsules 5, 10, 15 20, 25, 30mg XR	1 or 2 times a day. XR may be once a day.	Child: 5-30 mg XR 10-20mg Adoles: 10-40 mg XR 10-30mg Adults: 10-50 mg XR 10-30mg	IR onset: 30 min duration: 4-6 hrsXR onset: 30-60 min duration: 8-10 hrs	Similar to MPH. – see 1st chart
EVEKEO D and L amphetamine sulfate	tablet (scored) 5, 10mg IR	once to twice or rarely 3 times a day	Child: 2.5 – 20mg Adoles: 5-30mg Adult: 5-40mg	onset: 30 min. duration: 4-6 hrs	Similar to MPH – see 1st chart Same as Adderall IR	Very similar to Adderall IR tablets. Is a 50/50 racemic mix of L and D amphetamine. New in 2016. Brand
ADZENYS XR ODT orally disintegrating tablet D and L amphetamine	tablet: 3.1, 6.3, 9.4, 12.5, 15.7, 18.8mg XR	Once a day in AM Start 3.1 to 6.3 based on age and weight.	Child: 3.1 – 9.4 Adoles:3.1 – 18.8 Adult: 3.1 – 18.8	onset: 30-60 min duration: up to 12 hours	Similar to MPH – see 1st chart Same as Adderall XR	This is equivalent to Adderall XR and is the only orally disintegrating ADHD med. New 2016. Brand
DYANAVEL XR oral suspension D and L amphetamine	liquid suspension 2.5 mg/ml (1 ml = 1 cc)	Once a day in AM Start 2.5 mg Max 20 mg	Child: 2.5-10mg Adoles: up to 20mg Adult: up to 20mg	onset: 30-60 min duration: up to 12 hours	Similar to MPH – see 1st chart Same as Adderall XR	This is simply an Adderall like mixed amphetamine XR option in a liquid form. Does not need refrigeration. Comes ready mixed, shake before using. New 2016. Brand
VYVANSE (lisdexamfetamine)	capsule 10, 20, 30, 40, 50, 60, 70 mg XR	Once a day in AM	Child: 10-50mg Adoles: 20-70mg Adult: 20-70mg	onset: 30-45 min duration: 8-12 hrs	Similar to MPH – see 1st chart	Longer duration. Capsule can be opened and sprinkled on food. Pro – drug avoids IV and snorting routes of abuse. Brand only. May be gentlest amphetamine.

Non-Stimulants

Medication	Form	Dose/ Schedule	Dose Range	Onset/ Duration	Most Common Side Effects	Pro	Precautions
Strattera (atomoxetine)	capsules 10, 18, 25,40, 60, 80, 100mg	Once or twice daily. Start in AM. Give evening if sedation.	Based on weight, 0.5 to 1.5mg/kg, target 1-1.4 mg/kg	onset 30-60 min duration: 5-8 hrs, steady state	Stimulant side effects but milder (see Ritalin); plus sedation, nausea possible.	Increases norepinephrine (NRI) stimulant-like action but lasts all day. Not a controlled substance. No direct dopamine effect so may be better tolerated.	Takes 2 to 4 weeks for maximum effects. Must be taken 7 days a week. Only available as brand.
Tenex (guanfacine)Intuniv (guanfacine ER)	tablets 1.0 mg 2.0 mgtablets 1, 2, 3, 4 mg	Begin in evening. May need 3 times/day. No patch form. Must take 7 d/wk.Intuniv usually AM, once a day	child: 1.0-5.0mg Adoles: 1.0-4mg Adult:2.0-6mg	onset 30-45 min duration: 4-8 hrs	Less sedating than Clonidine, but can cause sedation, sometimes (25%) nightmares. May lower blood pressure.Intuniv is once a day in AM, longest duration, least sedating, often smoother and is a new brand.	Less sedating than Clonidine. Same other benefits. Can be given 2 or 3 times/day. May need 1-2 weeks to build up. Helps tics, hyperactivity. Does not cut appetite. Invented to treat high blood pressure. Generic available.	Will not help attention as much as stimulants. Do not stop suddenly, same as Clonidine. May rarely have unexpected heart effects.
Catapres (clonidine)Kapvay (clonidine ER)	0.1 mg 0.2 mg Patch (TTS-1/2/3)tablets 0.1, 0.2mg	Begin in evening due to sedation. May need to build up to 4 times/day. Patch on skin lasts 5-7 days. Must take 7 d/wk.Kapvay is usually AM. May be given BID.	Adoles: 0.1-0.6mg Patch up to TTS-3	duration: 3-5 hrs patch 4-7 days duration	Very sedating. May lower blood pressure, dizziness. Skin irritation common with patch.Kapvay is similar to Intuniv.	Helps tics. Helps severe hyperactivity and impulsivity. May need 1-2 weeks to build up. Does not cut appetite. Invented to treat hypertension. Has been used to treat opiate and/or nicotine withdrawal. Older, generic available.	Avoid if serious depression. Partial effect on attention. Taper off slowly to avoid rebound hypertension or agitation. May rarely have unexpected heart effects.

Created by Kevin Leehey, M.D., August, 2016 • www.leeheymd.com
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